Intubation
Personnel
If urgent intubation and consultant is off-site, call adult ITU for immediate assistanceTwo doctors minimum Kit
- Intubation trolley
- END-TIDAL CO2 MONITORING IS MANDATORY
- Laryngoscopes:
- > 18 months curved adult MacIntosh 3.
- <18 months, straight flat blade such as a Seward or Robertshaw or Cardiff blade can be used from birth to adolescence
- Tracheal tubes ( The formulas given below are only an estimate and are not a substitute for direct visualization of the tube position at the cords or tube placement on CXR)
- Cuffed tubes acceptable for all ages, but cuff pressure must be < 20cm H2O - usually only available for > 4.5mm tubes
- Gum elastic bougie
- Yankeur suction
- Laryngeal mask available
Drugs
Have the following drugs drawn up unless instructed otherwise
Anaesthetic drugs
Propofol 0.1 - 0.2ml/kg
Fentanyl 5mcg/kg IV
Midazolam 0.1mg/kg
Thiopentone 6mg/kg
NMJ blocker
Vecuronium 0.2mg/kg
Gas induction
This may be required for cases with a difficult airway - only set up the machine if you are an anaesthetist.
Notes
Post-intubation CXR mandatoryOnly cut the tube after CXR has confirmed position. Do not cut too short in patients who might become oedematous - this will cause the tube to migrate proximally
If the tube needs to be advanced or withdrawn, use sedation and consider paralysis
ETT size Guide
ETT diameter
|
ETT length at lips
|
ETT length at nose
|
Laryngeal mask size guide
Number |
Patient weight (kg) |
Inflation volume (ml. Of air) |
1 |
<5 |
2-5 |
1.5 |
5-10 |
3-8 |
2 |
10-20 |
5-10 |
2.5 |
20-30 |
10-15 |
3 |
30-50 |
15-20 |
4 |
50-70 |
20-30 |